Bill > HF875

This bill modifies Iowa's health insurance credentialing process by establishing new requirements for health insurers when processing credentials for physicians, advanced registered nurse practitioners, and physician assistants. The bill mandates that health insurers must respond to credentialing requests within 56 calendar days and provide a written explanation if a credentialing request is denied. It also formally defines key terms such as "credentialing" (the process of determining a healthcare provider's eligibility to provide services and receive reimbursement), "clean claim" (a term referenced from another section of Iowa code), and specifies the types of healthcare providers covered (including doctors of medicine and surgery, doctors of osteopathic medicine and surgery, registered nurses with advanced practice certification, and physician assistants). The bill maintains the existing requirement for retrospective payment of clean claims during the credentialing period, ensuring that healthcare providers can be reimbursed for services once they are ultimately credentialed. The bill is set to take effect on July 1, 2025, and aims to create more transparency and efficiency in the healthcare provider credentialing process.

Business and Industry

Commerce (House)

https://www.legis.iowa.gov/legislation/BillBook?ga=91&ba=HF875